Tag: pre-kindergarten

Potty-training can be a challenge for parents, but it’s also an important part childhood development. The normal struggle can be even more difficult when there are sensory processing issues. Recognizing that they need to go, wearing big girl or big boy underwear, and being able to use different toilets can all be impacted by sensory processing.

Why does Sensory processing matter?

Toileting requires a significant amount of body awareness. Children have to understand how their body is feeling, learn how to release their bowel and bladder muscles in order to go, and feel that they have “finished” and their bowel or bladder is now empty.

Sensory processing is a natural part of the toileting process.

A bathroom environment can be overstimulating to start with. We receive sensory information from our eyes, ears, skin, muscles, and joints and our brain’s job is to organize the information, select the important parts, and disregard the rest. When a child’s sensory systems are functioning appropriately, they are able to participate in activities of daily living such as potty-training. However, if the sensory systems are not integrated properly, toileting can become problematic.

what is Sensory Processing?

Sensory Processing refers to how the nervous system detects, regulates, interprets and responds to sensory information. Sensory Processing is an important factor in considering a child’s attention, memory, behavior, and function (Ahn, Miller, Milberger, & McIntosh, 2004; Gardner &Johnson, 2013). A child’s brain needs to be able to register sensory information from the environment and react appropriately to it. If a child has difficulty regulating and processing sensory information, they may have Sensory Processing Disorder.

Sensory Processing Disorder is a neurological disorder in which the sensory information that a child perceives results in abnormal responses. Children who have difficulty processing sensory information often have inconsistent responses because they have a hard time discriminating between which sensory information is important and which can be ignored.

It is important to note that many children (and adults for that matter) have difficulty with processing certain types of sensory input. Typical things such as disliking certain smells or textures, feeling seasick on rides, or preferring certain foods do not necessarily mean that a child has sensory processing disorder. They may simply still be learning to process certain sensory stimuli.

There are eight sensory systems in our bodies:

Tactile System (touch)

Vestibular System (balance)

Proprioceptive System (position in space)

Olfactory System (smell)

Visual System (sight)

Auditory System (hearing)

Gustatory System (taste)

Interoceptive System (internal body awareness)

Interoception is our ability to sense what is going on inside our bodies internally. It includes sensations such as thirst, hunger, fatigue, pain, breath, itchiness, nausea, temperature, etc. It also includes our sense of if we have a full bladder or bowel, and if we have “released” it. (Garland, 2014).

An Explanation of the Sensory Systems related to Toileting

The proprioceptive, vestibular, and touch senses are primary influences on the integration of our senses. The interoceptive sense also plays a crucial role in developing the foundational body awareness needed to function as a child.

When a child is unable to integrate and react to sensory information appropriately, the child will not interact with his environment in a functional manner. He may have exaggerated responses to typical noises or sensations or withdraw from certain stimuli. The child cannot consistently process sensory information, so their responses will be inconsistent, too.

If the child has decreased body awareness, they may demonstrate an inefficient grading of force or movement. For a boy, this may mean they have difficulty using the right amount of force when holding or aiming the penis. This might result in a child pressing so hard that it’s difficult to pee, holding too tightly, or having difficulty holding steady.

Our vestibular system helps us to maintain our balance. The fluid in our inner ear moves as our head moves, sending messages to our brain about where our body is in space (Abraham, 2002). Some children with vestibular dysfunction present with “gravitational insecurity“, which makes them seek a secure position during activities. They may dislike swings, being picked up, or participating in activities in which they are not in control of their body in space. These children might be fearful when attempting to sit on a “grown-up” toilet where their bottom is unsupported because they feel like they may fall.

Children with vestibular, tactile, and proprioception difficulties may have difficulty with eye-hand coordination and depth perception. It may be difficult for them to aim appropriately or estimate where to stand.

Many children with sensory processing difficulties have auditory sensitivities that interfere with toilet training. Think of the loud echoes, flushing toilet, the hand dryers, etc. Noises that are simply loud to an adult can be piercing to a child with auditory sensitivities.

Tactile sensitivities can interfere with toileting, too! Children may dislike the sensation of pooping, wiping, or even sitting on a hard seat. If they are under-responsive to touch, they may not realize that they aren’t covering their hand properly with the toilet paper, they aren’t wiping well enough to clean themselves, or that they’ve soiled their clothing.

Sensory Processing and Body Awareness needed for Toilet Training

When our body is able to receive and interpret the signals from our skin, muscles, and joints, we are able to feel and know what our body is doing without looking at it. When a child has poor body awareness, it can lead to difficulty coordinating their body to do all of the components that are involved in toileting. It is not automatic to feel the urge to go and just go to the bathroom. Each step of the task must be thought out and carefully performed, so it is important to be patient. It’s hard to know what to do if you can’t feel what you are supposed to feel!

Typically, toddlers and preschoolers spend a lot of time learning the “ins and outs” of toileting. Children are expected to be toileting independently before entering Kindergarten. Children with difficulties modulating sensory input find potty training to be a much bigger challenge than a typical child. The bathroom can be an overstimulating environment, so asking a child with sensory integration difficulties to focus on the task at hand (ie; peeing or pooping) is a challenge if they are overwhelmed with fear or anxiety about other sensory signals they are receiving. Problems with toileting and sensory processing might include (but not be limited to) the following:

Toileting and Sensory Processing Problems

1. Toileting and Sensory Processing Related to Poor Interoception

May be unaware that his bowel or bladder is full.

Feels that they need to go, but not be able to discriminate whether they need to urinate OR have a bowel movement.

Unable to “push” in order to go; don’t understand how to make those muscles work

Cannot feel that they have had an accident or that their clothes are soiled.

Unable to bend and reach behind them to properly wipe

2. Toileting and Sensory Processing Related to Sensory Defensiveness

Dislikes the feeling of “peeing” or “pooping” and withholds.

Fearful of falling into a regular sized toilet

Dislikes the feeling of wiping or being wiped.

Prefers the parent to wipe them

Does not like to wash their hands

Takes off all their clothes to use a toilet

Avoids flushing the toilet

3. Toileting and Sensory Processing Issues Related to Poor Registration of Sensory Input with a Hyperactive or Over-reactive Response

The child is fearful of the sensations involved when they pee or poop.

Reports that the act of “peeing” or “pooing” hurts terribly, crying, etc.

Extreme reaction to the sound of the flush or the air dryer

Gags, or chokes at the smell of the poop

Visually distracted by details in the bathroom, including lines in the tile, dust on the floor, etc.

Will tell you when the diaper needs to be changed, doesn’t want a wet diaper

Difficulty tolerating new bathrooms, public bathrooms, etc.

Covers ears when flushing, air hand dryer goes on, etc.

Holds nose for bowel movements

Avoids using certain toilets with “hard” seats

Avoids going into the bathroom, “sneaks off” to poop in diaper behind a couch, etc.

How to Help: 15 Amazing Strategies for Toileting

1. Try a 4 in 1 Stages Potty Seat which is closer to the ground and fits a smaller bottom. It also helps transition to use a grown-up toilet

2. Try fun potty seats like this Race Car Potty and Character Underwear that are motivating!

3. Try using flushable wipes and a Wipes Warmer to make the experience of wiping more enjoyable

* one consideration for this is that your child may begin to rely on it…. if you are out in public and don’t have warm wipes, will it be a problem? Take that into consideration before making it part of your routine. But if you are desperate, it’s worth a shot!

4. Sing Songs to make toilet training more fun:

“Let it go! Let it go!”

“Push it out, Push it out, WAY OUT!”

“Pee Pee in the Potty, Pee Pee in the Potty!”

“I just want to Potty all the time, Potty all the time, Potty all the time!”

5. Use painter’s tape to make a line for boys to know where to stand

6. Offer Toilet Targets or use goldfish crackers or fruit loops (get the pee in the hole!)

7. For children who aren’t sure if they have to pee OR poop, let them sit. It’s hard to tell which muscles are which.

13. Try a toileting schedule. Have your child sit on the toilet every 15 minutes for a few minutes. If they go, Wahoo! big Praise. If not, that’s ok, we’ll try again in 15 minutes.

14. Provide a Kitchen Timer for set “potty” sitting times. Let your child set the timer so they are a part of the process.

15. If your child is fearful of the sensation of pooping in the toilet, have them help you dump the poop from the diaper into the toilet and then flush it.

Toileting and Sensory Processing in Children with Special Needs

Very often problems with potty-training, such as accidents, difficulty recognizing if they have to go, struggles with hygiene, fear of flushing, and refusal to use the toilet are the result of an inefficient sensory processing system. It is important to note that children with developmental delays and other diagnoses may need more time to be trained. As parents and educators, it is essential to treat the process with patience. Your child has a lot of information and sensory signals to make sense of and every child has to go at their own pace. Do not feel the “peer pressure” from other parents that your child “should be” ready.

Functional Skills for Kids

This post is part of the Functional Skills for Kids series. See all of the bloggers who are participating and more about the series here. For more information on the components and considerations related to Toileting, stop by and see what the other Occupational Therapists and Physical Therapists on the Functional Skills for Kids team have to say:

The holidays are here! The holidays are here! Think of all the parties, the presents, the …stress!

Teachers are going nuts trying to get report cards done and review for tests in the middle of half days, plays, and holiday concerts. Parents are going crazy arranging childcare for the week off, planning holiday dinners, decorating the house, and finding the perfect gift for their family members.

Who has time to think of a teacher gift?

First, it is absolutely not necessary to give a gift to any teacher or professional that works with your child. They are simply doing their job and they get paid to do so. However, when your child has a special connection with a staff member, or you know that someone has gone out of their way to help your child, some parents like to give a little something to say thank you.

Parents often ask me for my favorite Sensory Resources. I recently did a parent workshop to speak about OT tips and trick for children with Sensory Processing Difficulties. I decided to put together a simple list of my go-to books, toys, and equipment for Sensory Processing. So here it is!

This post “Combining Handwriting and Play” is part of a year-long blog hop called Functional Skills for Kids. Each month, I will be working with other pediatric OTs and PTs to post on different developmental topics that impact functional skills for kids. I’m so honored to be working with some amazing pediatric bloggers to bring you a well-rounded blog hop that will ultimately result in a BOOK!

Busy Hands for a Fidgety Kid

Fidgets, Fidgets, Fidgets!

If you’ve been reading my latest posts, you’ll notice that I’ve been talking a lot about fidgets, fidgeting, and all things fidgety. Teachers are constantly asking how to help their students focus and how to keep them in their seats. Parents are looking for sensory toys to help their child succeed at school. There are many simple fidgets that you can supply a student with to keep busy hands quiet during class activities.

As I’ve recently posted, there are great little toys you can get at the dollar store that will do the job. But, sometimes you need something more. Something sturdy, durable, washable, AND fidgety. Today I’m excited to write about a new product I found called Fiddle Focus™ for Busy Fingers. It’s made by Creative Educational Strategies and Services. I had a great experience with one of my most fidgety Kindergarten kids ever. This product did the trick, so I’m happy to share my good luck with you.

*This post contains affiliate links

The Busy Hands tactile fidget is a tactile strip with four different patterns and materials set next to each other in a horizontal row. There is velcro attached to the back, so you can stick it to the underneath of a desk or a table if that is convenient.

My Fidgety Kindergarten Case

“Danny” was a 5-year-old boy who presented with all the classic symptoms of ADHD. He was inattentive, impulsive, and had a constant need to be moving. I worked very closely with the special education teacher in his co-teaching kindergarten classroom to make sure that Danny’s environment was set up so that he could learn. We tried a Seat Cushion for him, which helped him stay seated for longer periods of time. Then we added TheraBand to the legs of his chair, so he could kick while sitting at his Kindergarten work table. We gave him a weighted vest to wear during circle time, which he loved. So we had most of our bases covered.

Except for his hands.

Those fingers would seek out anything they could during lessons, resulting in untied shoelaces, tiny crayon wrappers all over the desk, you name it. I decided to try out the Busy Fingers from Fiddle focus. We had already tried Velcro under the table as a tactile fidget. The problem was that he kept peeling it off. Simply rubbing the Velcro wasn’t enough.

The Busy Fingers tactile strip turned out to be perfect. It comes with a velcro strip, so we stuck it to the underneath of his kindergarten table right at his seat. Now it was out of view, which didn’t make all the other kids ask about it.

But, when he got up to go sit on the rug, he was able to peel it off and take it with him. This way, his fingers were busy while the teacher taught her lesson of the day. Now, with the vest, the cushion, and the Busy Fingers, we had the tools we needed to help Danny focus. On a side note, Danny’s mom was on board with us trying all this stuff. He was just as inattentive and fidgety at home.

Danny’s special ed teacher told me that Danny was doing great with the Busy Fingers. She said “he’s playing with it while the teacher is teaching but he hears everything she says. It’s under the table so the other kids aren’t distracted, but he loves to reach for it in between lessons”. Sometimes it’s hard to understand that a child can still hear everything you say even if they aren’t looking at you. But the same is true for us. How often do we watch TV, read a book and have a conversation with someone at the same time? Not everyone’s brains are wired to concentrate on one thing at a time. That’s okay. As long as you get done what needs to get done, it’s all good.

Products for your Fidgety Kid:

Strengthening is easy to include at school

One of my favorite exercises to do with both adults and kids is resistance band. There are dozens of ways to use resistance band to improve strength, balance, posture, and coordination. One problem that I often encounter with children is that they can’t figure out where to put their hands during the exercises. Even if I start them off in the right spot, their hands slip too far down for correct positioning. So I was thrilled to find the Handee Band, a yellow resistance band with two hand prints in the perfect spot for little hands.

The stand-up easel book is easy to flip and utilize for kids, teachers, and parents!

An easy “Brain Break” and it strengthens, too!

I discovered the Handee Band at the American Occupational Therapy Association (AOTA) conference Expo. I was excited about the hand prints on the band, but I was even more psyched about the Handee Band booklet with exercises, stickers, and checklist for the kids to check off what exercises they’ve done. It’s so easy to use and it’s perfect for a quick brain break, warm-up, or transition activity. Kids love to move, and the Handee Band flip book and resistance band is a fun easy activity that a teacher can use throughout the day. Teachers often ask me for ideas or materials for kids that “can’t sit” during circle time, etc. I am definitely adding the Handee Band to my bag of tricks.

The checklist is dry-erase, making it easy to use to track the whole class or an individual child. Just erase and use again next time!

Each monster features a different exercise, making it fun and easy to perform each activity.

My mind immediately started spinning about all the games and activities I could create for my classroom push-ins. In the past, I’ve also created homework programs so that the parents of my kids could work on strengthening and fine motor skills at home. The parents and the kids have always responded really well. Of course, I started brainstorming right then and there about the homework program I could create with the Handee Band.

This is a sponsored post, which means that I was provided with materials in order to write this post and put all my ideas into play. However, all of the opinions and ideas expressed in this post are mine and mine alone. For more info, read my disclaimer.

The flipbook includes an easy zip-up bag to hold the resistance band and dry erase marker. Easy to store and easy to transport!

About the Handee Band: The Handee Band exercise kit was created by an Occupational Therapist named Francesca Avalli. The booklet explains 15 different exercises, each with its own cartoon monster. Each page lists the name of the exercise with simple, easy-to-read directions to ensure that teachers and parents are helping their students to perform the exercises correctly. The booklet is a stand up easel which makes it is easy for kids to flip over the pages. It also has two checkoff pages in the back, so kids can visually track and match the monsters with the days of the week. The checkoff and dry erase marker are perfect for keeping track of how many reps of each exercise the child performed. I also find that when kids are figuring out how to do the exercises with the bands, they are working on their motor planning skills and their ability to follow directions.

Using the Handee Band for Classroom Strengthening Games:

The Handee Band exercise kit works great all by itself. It’s easy for a parent, teacher, or therapist to use the book or the E-book. Extra bands are available for separate purchase for as little as $5 so that there is enough for each child. Once I bought the Handee Band, I started using it right away. However, I am a little crazy that I like to change things up and give the kids “something different” when I push-in. The stickers in the Handee Band booklet are perfect for creating classroom games and activities. The Handee Band is also available in 5 or 10 packs, which is perfect for working in groups or with a class. You can buy extra stickers, too. They’re my favorite! So here are some of the games I came up with…

Get 15% off until May 31st, 2018

1) Handee Band Memory

I love to combine gross motor exercise with visual perceptual skills. Memory is a classic game that can be played individually or with a small group. I decided to create a “Handee Band” Memory game using the Handee Band Monster stickers. Each Monster has a Character name under his picture. I decided to adapt the game by having one version with the picture of the monster on one card and the name of the character on the other card. This was perfect for my 3rd grade self contained class. I made a simpler, more classic version for my self contained Kindergarten class. Both versions were a hit! And, after I played the game with the kids a few times, they grew familiar with which exercise each Monster represented. I was able to leave the game and the Handee Bands for the teachers to use as a warm up or a sensory break.

Instructions: Like the classic memory game, with a twist. A child attempts to find two cards that match. When any child in the group makes a match, ALL the children do the exercise that Monster represents. After the class does a set of ten, the kids get back to the next turn.

2) Handee Band Dice

My students love to play gross motor games using dice. I’ve adapted these dice from the Dollar Tree for other gross motor games in the past. So I thought, “Why not Handee Band Dice?” Again, I used the stickers to create a simple easy game to play during class Occupational Therapy sessions. The kids had a blast! I was able to leave the Dice game for the teacher to use with the kids as a reward, as a sensory break, or as a quick warm up.

Instructions: The children stand at their desks or in a circle on the rug, each with their own Handee Band. One child picks a die and rolls it. Whatever “Monster” the die lands on, everyone does a set of ten for that exercise.

3) Handee Band Spinner

Every kid loves a Spinner! Flicking a spinner is hard work; requiring separation of the two sides of the hand (pinky side and thumb side), motor planning, and dexterity. But even when a child can’t flick a spinner, they can still swipe or hit it. For this game, the children take turns flicking the spinner. When the spinner lands on a certain monster, the kids grab their Handee Bands and do that exercise ten times. As the children grow stronger, the repetitions can be increased.

The rules are simple: The children take turns flicking the spinner. Whatever “monster” the spinner lands on, the whole class does that exercise. Then the next kid gets a turn.

4) Handee Band Class Checkoff

This magnetic dry erase board is perfect to stick right on the teacher’s desk!

I loved the Dry Erase Checklist in the back of the book so much that I decided to create a larger “class wide” version for the kids to use during the Handee Band classroom games. I used the stickers to copy the chart in the back. Again, the checklists require visual tracking and matching skills, so the kids are working on visual perception as they keep track of their progress. I just used a plain dry erase board . I arranged the stickers on the board and made lines so that it could serve as a Class chart.

My favorite thing about the chart is that the kids can use it to track the number of exercises they did. It also works on math skills, because the kids need to add by ten each time they do another rep. In a pinch or a rush, the teacher can keep track on the board while the kids keep working. Either way, my students love having a “chart” to represent how hard they’ve worked. When I made the chart, I made the lines with a sharpie (permanent marker), but I wrote the initials of my kids in dry erase. This way, I can use it over and over for years to come!

The E-Book comes with a downloadable checklist, perfect for keeping track of hard work!

15% off UNtil MAY 31st, 2018!

Using the Handee Band for a Homework Program:

Kids love to show off to their parents and caregivers, but they love to show off to their friends even more! Once the kids understand how to do each exercise, the Handee Band Kit is perfect to send home as “OT Homework”. I have put together homework programs for my classes before in an effort to ensure carry-over into my student’s homes. Most parents love an easy fun way to help their children grow stronger. The Handee Band Exercise Kit is the perfect lightweight homework that kids can take turns bringing home. OT’s and teachers can make an “O.T. Homework Chart” to keep track of whose turn it is to take the Handee Band Kit home. My kids love to come in in the morning and put their sticker next to their name to show that they did their “O.T. Homework”. I always include a letter to the parents explaining why the students have “O.T. homework” and why carry-over is an important part of progress.

Strengthening Homework! What a great idea!

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Handee Band: Resistive Band Exercises for Kids *The Handee Band kit and E-Book are available for purchase at www.HandeeBand.com. You can also purchase individual or class packs of the bands and extra stickers. It’s perfect for home or the classroom!